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Management of specific medical conditions and medications 

Management of specific medical conditions and medications
Chapter:
Management of specific medical conditions and medications
Author(s):

Dr Jonathan P. Thompson

, Dr Simon J. Howell

, and Dr Richard J. Telford

DOI:
10.1093/med/9780199594429.003.0004
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date: 19 October 2019

Most patients presenting for vascular surgery or other interventions have other co-existing medical conditions. The commonest are coronary heart or other cardiovascular diseases, but diabetes, renal disease, chronic obstructive pulmonary disease are also highly prevalent. The vascular anaesthetist needs a full working knowledge of all the disorders potentially present in vascular surgical patients. This chapter comprises up-to-date summaries of current management of all these common relevant conditions. It covers all the fundamentals of diagnosis and treatment, optimisation before surgery where appropriate, and a guide to perioperative care. Written in a ‘How to do it’ style, it contains updated algorithms from international sources including NICE, the American College of Cardiology and American Heart Association, the European Society of Anaesthesiology, NHS Diabetes, and NHS Improving Quality. Topics include specific guidance on how to manage the patient with hypertension, heart failure, arrhythmias, pacemakers and ICDs, ischaemic or valvular heart disease, or a recent PCI, in the perioperative period. Current advice on managing diabetes, chronic kidney disease and chronic obstructive pulmonary disease are included. A separate section discusses the anticoagulated patient, detailing perioperative bridging therapy for patients taking warfarin. Another section describes some uncommon diseases (e.g. systemic vasculitides, thrombophilias) associated with vascular disease and their treatment. Overall, this chapter specifies all essential information needed by the vascular anaesthetist for the management of the vascular patient with co-existing disease, based on current best evidence. It will also be very useful for other practitioners involved with patients undergoing vascular interventions.

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